Information Collection

Defense Sexual Assault Incident Unrestricted Reporting

IC 200363 under ICR 202105-0704-001 · OMB 0704-0482.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0482 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD Form 2965 Defense Sexual Assault Incident Unrestricted Reporting	Form
DD Form 2965 Defense Sexual Assault Incident Database (DSAID) Data Fo DD2965 draft 20211014.pdf	Form
DD Form 2910 Victim Reporting Preference Statement DD2910 draft 20220110.pdf	Form

IC Title:

Defense Sexual Assault Incident Unrestricted Reporting

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DD Form 2965	Defense Sexual Assault Incident Database (DSAID) Data Form	DD2965 draft 20211014.pdf		Yes	Yes	Fillable Fileable
Form	DD Form 2910	Victim Reporting Preference Statement	DD2910 draft 20220110.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title: DHRA 06 Defense Sexual Assault Incident Database

FR Citation: 79 FR 38534

Number of Respondents: 5,640

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,640	4,942	698
Annual IC Time Burden (Hours)	14,100	12,355	1,745
Annual IC Cost Burden (Dollars)	370,999	325,085	45,914

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.